Can New York Pull Off Single-Payer Healthcare?

The US Healthcare System is Broken. New York Could Lead the Way to Fixing It.

The New York Health Act proposes single-payer healthcare which would do away with the private insurance companies.

About 10 years ago, when she was 44, Eve Madalengoitia had a hunch that something was wrong. She was experiencing concerning symptoms of the lady sort, and her doctor said it's probably nothing, but let's get you an MRI to be sure. At the time, she was working as a consultant from her home base in Poughkeepsie, writing grants and fundraising for nonprofits; her husband was a self-employed artist. They didn't have health insurance. The expense of an MRI (ballpark $2,600) was so daunting that Madalengoitia convinced herself that her symptoms were nothing to worry about. She was young and healthy, wasn't she?

A few months later she got insurance through a new job, so she went ahead and scheduled the exploratory test. Soon after, she received some news that no one expected. "I had aggressive, high-grade uterine cancer, which was not common in women my age," she says. "I needed immediate surgery, chemo, and radiation." Thankfully, her insurance paid for it, and now she is NED (no evidence of disease). But she is keenly aware of the what-ifs. "Without health insurance, I probably wouldn't have gotten the test and the cancer would have spread," Madalengoitia says. "I wouldn't be here to tell my story."

Madalengoitia's experience is pre-Obamacare, but even people who have health insurance often forgo medical tests and treatment because of high deductibles, coinsurance, copays, or all of the above. Even for those with employee-provided insurance, out-of-pocket healthcare spending has increased by more than 50 percent since 2010, according to human resources consultant Aon Hewitt. Medical debt is the number one reason why Americans file for bankruptcy, according to financial services company The Motley Fool.

We may pride ourselves on our high-quality medical care, but Americans spend almost twice as much money on it, as a percentage of our economy, than other advanced industrialized nations ($3.3 trillion, or 17.9 percent of our GDP in 2016). And we're no better for it: Our health outcomes are poorer and we die younger than citizens of other wealthy countries. It's not the amount of healthcare we consume that is the problem: It's the cost of healthcare. As long as big pharma, big insurance, and big hospital networks are calling the shots, we're unlikely to see these costs go down. And as long as we skimp on social services for our underserved populations, many experts say, we're unlikely to see our life expectancy go up.

A Little-Known Bill Is Gaining Momentum

When it comes to troubling scenarios like these, our lack of universal healthcare is the elephant in the room: It's a huge marker for our poor health outcomes and financial dire straits. We're the only major industrialized nation in the world that does not have universal healthcare. After Hillarycare was famously shot down during Bill Clinton's presidency, the idea receded from the public discussion. It didn't get major play again until Bernie Sanders made his Medicare for All proposal a cornerstone of his rousing campaign in the 2016 Democratic presidential primaries. President Trump's potshots to the Affordable Care Act are not helping to keep Americans insured—but they may be pushing states to devise their own solutions. Several states, including Sanders' home state of Vermont, have made or continue to make efforts to design single-payer programs. What many New Yorkers don't realize is that the Empire State, too, has a single-payer bill floating around in Albany.

It's called the New York Health Act, and it is not new: First proposed in 1991, it's been through many incarnations. In its current form, the bill has p-assed in the State Assembly by a wide margin for the past three consecutive years. Yet a Republican majority in the State Senate means the bill has not made it out of the health committee and onto the agenda for a vote. That could change quickly, as the bill has 31 co-sponsors in the 63-seat State Senate, and only one more co-sponsor is needed to tip the balance.

"The healthcare system is rigged against working people, and the Trumpadministration is working to make healthcare access even worse," says Assembly Health Committee Chair and bill sponsor Richard N. Gottfried, who originally authored the 1991 bill. "New York can do better with an 'improved Medicare for all' single-payer system that covers all of us and is funded fairly. Support is growing with the public and in the State Senate. I expect the Assembly will pass the bill again this session, an important step as we continue to build support for universal healthcare in the face of the Trump agenda."